Opioids are chemical substances that have a morphine-like action in the body. The main use is for pain relief. These agents work by binding to opioid receptors, which are found principally in the central nervous system and the gastrointestinal tract. Opioids include (1) natural opiates, such as (−)-morphine; (2) semi-synthetic opiates, such as heroin; (3) fully synthetic opioids, such as methadone; and (4) endogenous opioid peptides, produced naturally in the body, such as endorphins and enkephalins. The term opiate and opioid are used synonymously here. Although opiates technically cover natural opium alkaloids and the semi-synthetics derived from them.
Opioid addiction is recognized as a central nervous system disorder, caused by continuous opioid intake. The ability of opioids to cause addiction can be viewed as a form of neuronal plasticity (Dani et al., (2001) Neuron 31:349-352). Indeed, chronic opioid exposure has been shown to produce profound biochemical changes in specific brain regions thought to mediate the reinforcing or addicting actions of the drugs (Pilotte, (1997) Curr. Opin. Neurol. 10:534-538). The dopamine-containing neurons that originates in the ventral tegmental area (VTA) projecting primarily to the nucleus accumbens (Acb) and the prefrontal cortex are an integral part of the neural reward circuitry that has been shown to be crucial for self-stimulation, behavioral sensitization and the dependence produced by opioids (De Vies and Shippenberg, (2002) J. Neurosci. 22:3321-3325). Dopamine is the principal neurotransmitter and neuromodlator that mediates reinforcing effects.
It is well known that opioids cause functional changes in dopamine-containing neurons that spread widely within these neurons. This results in an increase of neuronal activity and dopamine release from these nerve terminals (Schultz, (2000) Nat. Rev. Neurosci. 1:199-207). Extended opioid use leads to the nerve cells in the brain to stop functioning as they normally would and stop producing natural endorphins. Because the body is getting opioids and no longer is producing endorphins the nerve cells start to degenerate and cause a physical dependency on opioids. Sudden withdrawal (quitting cold turkey) leads to a syndrome called withdrawal syndrome. Withdrawal syndrome is a long and painful process and can result in permanent damage to the cardiopulmonary system and the central nervous system. Untreated and unmonitored, it can result in death for unhealthy individuals. For these reasons, opioids dependency treatment requires appropriate and responsible medical care.
Traditionally there have been several forms of opioid detoxification including opioid agonist drugs. These include drugs like methadone, levo-alpha-acetylmethadol (LAAM), or Buprenorphine; Clonidine, which blocks some withdrawal symptoms; ultra-rapid opioid detox under anesthesia; and an experimental method using the drug lofexidine. Opioid agonist drugs act like opioids but do not produce the same high and are administered in doses that are gradually reduced. Since these medications act like opioids there appear to be no noticeable or significantly reduced withdrawal symptoms.
Clonidine can be administered by a transdermal patch, which dispenses the drug gradually and consistently over a seven-day period. Individuals who choose to use the patch should also take Clonidine orally for the first two days since medications taken through the skin takes two days to reach a steady effectiveness. Monitoring of blood pressure is essential since Clonidine causes hypotension and sedation.
Another method of treating Rapid detox is done under general anesthesia with intubations for six to eight hours. During this time a combination of drugs, usually naltrexone and Clonidine are administered to the individual. Lofexidine, a non-addictive drug brought to the market in 1992, is a centrally acting alpha-2 adrenergic agonist targeted for relief of opioid withdrawal symptoms.
Withdrawal symptoms continue to be the greatest obstacle in heroin detoxification treatment. Studies show that there is no proof that one detoxification treatment is better than another. Relapses continue to occur in numerous cases around the world therefore making opioid addiction very difficult to treat successfully long term. Studies show that on average addicts will stop and start detox 10-25 times in their lifetime relapsing back to opioid use each and every time.
Statistics and studies show that there is no easy cure for opioid treatment and there is no guarantee that a relapse will not happen. New methods to use for opioid detox, one must choose the method that looks at their general health condition, psychological state, external support and length of time addicted and making an informed decision that best meets the needs of the individual. Therefore, alternative methods effective for treatment of addition would be a desirable contribution to the art.